Urgent Care and Emergency Department Visits in the Pediatric Medicaid Population

Area of Science:

• Health Services Research
• Pediatric Healthcare
• Health Economics

Background:

• Urgent care (UC) is a rapidly expanding healthcare delivery setting.
• Emergency departments (EDs) are frequently utilized for pediatric care.
• This study compares pediatric UC and ED visits that do not require hospital admission.

Purpose of the Study:

• To compare clinical and cost attributes of pediatric urgent care and emergency department visits.
• To identify potential cost savings by analyzing differences in severity and payments.
• To assess the feasibility of transitioning lower acuity cases from ED to UC.

Main Methods:

• Analysis of 5,925,568 pediatric visits (under 19) to EDs and UCs from the 2010-2012 Marketscan Medicaid Multi-State Database.
• Comparison of basic demographics, diagnoses, severity, and payments between ED and UC visits.
• Statistical analysis using chi-squared tests for proportions and Wilcoxon rank-sum tests for continuous variables.

Main Results:

• UC and ED shared the most common diagnoses; over half of UC visits were low severity.
• EDs had higher return visit rates within 7 days (8.4% vs 6.9%) and primary care follow-up (22% vs 17.2%).
• UC payments were significantly lower (median $76.90 vs $186.20), with potential national Medicaid savings exceeding $50 million annually if low-severity cases shifted to UC.

Conclusions:

• Pediatric UC and ED visits share common diagnoses, return rates, and admission rates.
• UC visits are characterized by lower severity and significantly reduced costs compared to ED visits.
• Transitioning lower acuity cases from EDs to UCs presents a substantial opportunity for cost savings within the Medicaid system.